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Organization
REVIVE DENTAL AESTHETICS LLC
Active
Organization
REVIVE DENTAL AESTHETICS LLC
Active
Other names
Revive Dental Aesthetics
Organization subpart
No
Provider details
NPI number
Authorized official
VERONICA GE DMD (OWNER)
(803) 380-8018
Entity
Organization
Contact information
Practice address
2220 DAISY LANE, SUITE D105, INDIAN LAND, SC 29707
(803) 380-8018
(803) 380-8003
Mailing address
2999 HOLBROOK RD, FORT MILL, SC 29715-7034
(803) 380-8018
(803) 380-8003
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
03/31/2026
Last updated
03/31/2026
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